Clinical and radiographic course of early undifferentiated arthritis under treatment is not dependent on the number of joints with erosions at diagnosis: results from the Swiss prospective observational cohort

Abstract

ObjectiveTo analyse whether early arthritis patients who do not fulfil the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) 2010 classification criteria for rheumatoid arthritis (RA) have a different course of the disease dependent on whether they can or cannot be classified as RA because of radiographic disease (EULAR task force) at diagnosis.MethodsFor this observational study within the Swiss RA cohort SCQM, we included patients with early undifferentiated arthritis (disease duration ≤1 year), who had not received any previous disease-modifying antirheumatic drugs (DMARDs). 2010 ACR/EULAR criteria negative patients were separated into two groups (radiographic vs non-radiographic arthritis) depending on whether or not they had radiographic changes defined as erosive disease by a EULAR task force (≥3 joints with erosions). The primary outcome measure was the radiographic progression detected employing the Ratingen erosion score. Health Assessment Questionnaire (HAQ) and DAS-28 were used as secondary outcome measures. The average observation period was 4 years.ResultsA total of 592 patients were analysed. 240 were not classifiable as RA by application of the 2010 ACR/EULAR criteria at baseline. In 57 patients, radiographs at the first visit were not available. 133 patients had radiographic arthritis and 50 non-radiographic arthritis. Treatment was initiated in all patients with DMARDs, mostly methotrexate. No differences in DAS-28 and HAQ scores were found during follow-up. The average erosion scores were higher among patients with initially radiographic arthritis throughout the study. The progression of erosion scores over time, however, was higher in patients with initially non-radiographic arthritis with less subsequent radiological progression (3.3 erosions/year vs 0.4, respectively, p<0.0001).ConclusionsThe clinical and radiographic course of early undifferentiated arthritis under treatment was not dependent on the presence of erosions in three or more joints (ie, the definition of radiographic disease by the EULAR task force) at diagnosis in our cohort.

Comparing the disease course of patients with seronegative and seropositive rheumatoid arthritis fulfilling the 2010 ACR/EULAR classification criteria in a treat-to-target setting: 2-year data from the ARCTIC trial

“… 20 However, a recently published study has shown that the clinical and radiographic course in ACR/EULAR 2010 negative patients under treatment was not dependent on the presence of erosions at diagnosis. 21 …”

Characterization of patients with undifferentiated arthritis and evolution to other inflammatory diseases in a Colombian northwestern cohort: An observational study

“…Asimismo, se identificaron pacientes que progresaron a otras artropatías, en su mayoría a AR, lo que es similar a otras cohortes (19)(20)(21) reportadas en la literatura y sin diferencias significativas a lo reportado a nivel local (13).…”

“…Se encontró que la mayoría de los pacientes eran de sexo femenino y fueron diagnosticados en un rango de edad entre los 45 y 50 años, similar a lo reportado en otras series previamente publicadas (21).…”

Diagnostic Challenges and Management Update in Rheumatoid Arthritis

“…While early signs and symptoms of RA can be mimicked by other diseases, there are some which should be taken into consideration, such as fatigue, minimal joint pain, joint warmth, joint stiffness, limping, reduction of range of motion, fever, anemia, and depression. It is easy to see that all these are not at all specific, not even for full blown rheumatoid arthritis and even less so for early/very eRA [35].…”

“…This symptom can affect relationships, emotions, mood, productivity, creativity, the general feeling of happiness. Fatigue from RA can associate with poor appetite and weight loss [35].…”